Protect: the city was built first and foremost as a rampart, against enemies from the outside and against a hostile nature… but also against enemies from the inside, such as epidemics. Leprosy, cholera, smallpox, measles, scarlet fever, typhoid, the plague, tuberculosis… These have shaped urban planning and city architecture, long seen as tools in the service of public health. The current health situation marked by the Covic-19 epidemic should not make us forget that modern medicine, its therapeutic innovations and its advanced technology have been remarkably effective in removing the danger of epidemics from the horizon. Neither should it lead us to underestimate the weight of a new type of epidemic, that of non-communicable and chronic diseases, known as “civilizational” diseases which can also represent co-morbidity factors likely to aggravate an infectious disease. The treatment of allergies, cancer, obesity, diabetes, cardiovascular and pulmonary diseases, mental disorders and mental illness represents a challenge both for medicine (the curative approach is proving insufficient) and for national economies, while the economic burden of these diseases is estimated to double over the next twenty years.
This new horizon of danger requires us to reexamine the link between health and the environment. Health is a complex concept that depends both on factors inherent to the individual (physiology, biology, mental or emotional state) and on factors related to his interactions with his environment (social, economic, cultural and spatial). Several socio-environmental and epidemiological studies have shown the role played by urbanization and associated lifestyles in the emergence of civilizational diseases. How can the environment be rethought to compensate for the potentially pathogenic effects of city life? The shift from a curative to an environmental health approach opens up some very interesting and promising avenues for action that are at the origin of a new way of considering urban planning and architecture: reduction of pollutants, nuisances and other deleterious agents, promotion of healthy behaviors in individuals (physical activity and healthy eating), facilitation of social cohesion, reduction of health inequalities and support for vulnerable people, strengthening of interdisciplinarity (particularly between urban planners, physicians and sociologists), involvement of all stakeholders, including citizens and, finally, synergy between different public policies (environmental, planning, health). However, can health be reduced to the mere absence of disease? Since 1946, the World Health Organization has defined it as “a state of complete physical, mental and social well-being” and as “a resource for daily life”. Can the ambition to compensate for the deleterious effects of urbanization be sufficient? Would not it be necessary to promote an approach no longer focused solely on pathology and risk factors, but rather a holistic and above all positive one? Could not work on urban morphology, the redevelopment of public spaces, the invention of new architectural forms, the construction of infrastructures and the development of new technical processes enable cities to be healthy?
While everyone agrees on the fact that we wish to live in an environment that will not harm health, more proactive positions should encourage caution: on the one hand because it is in fact difficult to establish proven mechanisms of positive causality between city and health; on the other hand, because the link between health and the environment is anything but neutral. At its heart lies a tension between the objective of preserving health and a hygienist injunction to the “good life”. The actions carried out in favor of indoor air quality clearly show this: centered on the adoption by the user of “good gestures” and “good behaviors”, the questions of industrial policies at the origin of indoor air pollution, of inequalities in the face of this public health problem as well as the question of our lifestyles leading to prolonged exposure to this risk factor are not addressed.
The issue raised by the question of healthy cities is that of the inhabitant. What is their place and role when we move away from a strictly individual conception of health to take into account that the influence of the environment on each individual’s health has a collective dimension?
→ Related: our report about active and healthy cities just came out: discover it on our website (in French).
